When hospice reverts to the lowest common denominator and leaders obsess about metrics, it's time to speak. Self-inflated leaders assume clinicians give until their backs break, given no raises for years. A clinical ladder is a rainbow’s pot of gold. Others have a sorrier job and must be motivated by money. Abysmal leaders dangle extrinsic rewards for admission, hiring and EDBITA targets. “Sign on” bonuses entice people into a poor work environment. Employees’ voice equals their raise, zero.

Friday, January 30, 2015

I left work today for the last time as a Gentiva employee. Monday morning I work for a division of Kindred Healthcare. Top Gentiva executives offered golden parachute goodbyes today. Executive Chairman Rod Windley and CEO Tony Strange will take their millions and ride.

The role we will miss most is being cheerleaders and supporters for the field.

When do cheerleaders and supporters surreptitiously reduce PTO benefits and the employer health insurance contribution, while giving one measly raise in seven years? What cheerleaders leave with millions ($) apiece while granting employees a one time loyalty bonus in the hundreds? How can supporters ignore long term, obscene levels of turnover in the "greatest group of employees in the industry"?

My fellow employees were grateful for the final crumb from the executive banquet table. It had been awhile since we'd had a taste of what they dine on three times a day. Will Kindred's leaders be different?

Kindred hired a new Chief Operating Officer from an affiliate of private equity firm Warburg Pincus. Gentiva acquired Harden Healthcare's home health and hospice division from Capstar Partners, also a private equity firm.

Through Gentiva's heavy handed integration of Harden expected combined revenues fell short, turnover increased and goodwill written down. The cause? Bad management in the words of one higher up. I found that to be quite a confession from this group of "cheerleaders and supporters."

Kindred bought Gentiva's sites, but many are shells of their August 1, 2014 self. Our depleted site starts anew on Monday under Kindred management. Signs are costs will continue to be managed to the detriment of employee retention and customer service.

My plea would be for honesty, listening, partnering and giving employees what they need to serve well. That includes tools, time and fair compensation. If Kindred continues Gentiva's abusive management practices, don't imitate the last regime. Please don't mask your cuts, discounts or unrealistic expectations with flowery lies.

Sunday, January 25, 2015

One of the most dramatic business story lines last summer was the
back-and-forth merger battle between Kindred Healthcare and Gentiva
Health Services. The two post-acute care providers ultimately agreed to a $1.8 billion merger deal in October.

Kindred President and Chief Operating Officer Ben Breier,
who will take over as Kindred's CEO this March, said the company has
created an “integration management office” to oversee the melding of the
two companies, composed of Kindred executives and consultants.

Originally,
Kindred predicted that it would save $35 million in the first year of
the merger and $70 million in year two. It now expects to exceed those
estimates. “We're very bullish on what we're seeing on the cost side,”
Breier said.

This may sound familiar to Gentiva employees as executives used similar language regarding the Harden acquisition. While senior executives bulled on the cost side, revenue expectations for the combined company were adjusted down more than once. It's not clear senior leaders understand the long term importance of employee retention, maintaining service levels and stable brand recognition in local communities.

Hospices are scrambling to consolidate so they can benefit from the
economies of scale and marketing advantages of being big.
Publicly-traded companies are responding to investor demands for
increasing revenues.

At least one company, Adaptive Insights, hopes to retain Gentiva's business and not be driven out in Kindred's cost reduction effort. It claims to have provided $1 million in annual benefits.

Gentiva needed a more flexible, cloud-based financial planning
solution that could support its complex business model, M&A growth,
and productivity, with limited reliance on IT. Adaptive Insights helped
Gentiva to model its mergers and acquisitions, and the Adaptive
deployment grew from a divisional level to quickly become the corporate
standard for all of Gentiva.

Currently, Gentiva's entire organization uses Adaptive
Insights for budget planning -- providing a 360-degree view of the
company, for all users. Gentiva's users have reported significant time
savings, and Adaptive's budgeting process has reduced workloads by more
than two months for the finance team.

Will Adaptive Insights be kept or ejected by Kindred's executives and consultants? That question applies to many of us who've lived Gentiva's knee jerk management for years. What is our future with the new company? "Bullish on the cost side" is a bad sign.

Monday, January 19, 2015

Secondly, as part of consummating the Gentiva transaction which we announced publicly, we expect to close on February 2 here. So just in a
couple of weeks. We will become the largest provider of home health and hospice in
the country. Well over $2 billion of revenue, approaching almost $2.5
billion of revenue. Included in that is about $850 million of hospice
revenue, the rest of it being on the
home health, skilled nursing side and personal care side in a place that
as we will talk more about our integrated care strategy, we at Kindred
Healthcare believe that as the consumer continues to be more responsible
for their first dollar out of
pocket, as medical technology continues to improve and as our ability to
continue to take care of a patient at the end of their stay grows that
being able to provide care in the home is going to be more and more
important in the future of healthcare
delivery. And so being the largest in the home care space is very, very
important to us as well.

That's twelve days before Valentine's Day. Time will show how much love Kindred shows Gentiva employees. Here's the close from Kindred's President and CEO Ben Breier:

As I mentioned earlier, not only you know are we confident in the work that we’re doing today in the context of integration, but that we believe that this is moving us into higher revenue growth businesses, as I mentioned earlier with higher EBITDA margins, better growth rate characteristics than what we’ve ever had at any other time in the history of Kindred.

We take a lot of pride and spend a lot of time thinking about the leverage aspects of our Company and we’re going to work hard, investors, equity investors should note we’re going to spend a lot of time this year and beyond thinking about the continued focus on delevering our Company. We’re in a reasonable position now, but certainly as we start to grow into Gentiva, we’d like to get that leverage number into sort of the 5 times range and ultimately as we get through the first two years of the Gentiva close, we think that investors should expect us to be sort of more in the 4.5 range from a leverage perspective.

And so last — just from I think to a close from an investment perspective and an investment rationale perspective you know, we aspire to do really what we hope are amazing things inside of the healthcare delivery system. We really do think that we’re in a position to reshape the way healthcare is delivered for an aging population in America which we take very importantly. We think that, as I mentioned, we’re uniquely positioned in a fee-for-service world today to move our fee-for-service business into more of a value-based purchasing environment where over the course of the next couple of years, people will want to pay us for taking care of a patient more broadly. This continue the care strategy that we have developed, we think is absolutely a strategic advantage to how we deliver care out in the marketplace. If you think about our business today and how it compares to any of our competitors out there really, there is nobody that has the deep local market penetration with the broad national scale that we have to manage costs but really develop brand and be able to take care of patients all across the continuum like Kindred Healthcare does.

And as we continue to connect the dots on health information, IT, and on care coordination, we will continue to be much more effective at how we manage these patients. You know we’ve had transformational growth, there’s no question about it. I mean, both doing Gentiva and Centerre, it represents, I think, certainly the strength of the back office of our Company and our ability to integrate these businesses. And so this transformational growth you will continue to see play out over the course of 2015 which will have a strong growth profile with, as I said, improving margin characteristics. We will have you know what we think are substantial operating cash flow possibilities with a deleveraging profile.

Thursday, January 15, 2015

In three months time Gentiva's employment numbers dropped 5,000 people, according to Kindred Healthcare. Kindred plans to close on Gentiva in early February. Gentiva leaders say few changes will occur at the site or branch level. How many of the missing 5,000 came from local operations vs. corporate layers? Kindred did not break that out.